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°¡µð¾ðÁöÁ¤¾È³» AUTHORIZATION FOR TEMPORARY GUARDIANSHIP OF MINOR (¹Ì¼º³âÀÚ ÀÓ½ÃÈİßÀÎ À§ÀÓ¼) Child (¾Æµ¿) Full Legal Name(¼º¸í):______________________________________________________ Date of Birth (»ý³â¿ùÀÏ): _________________ Age(³ªÀÌ): ________ Gender(¼ºº°): ________ Parent(s)/Legal Guardian(s): (ºÎ¸ð/ÈİßÀÎ) Parent #1: (ºÎ¸ð1) Name: (¼º¸í)_________________________________________________ ___ Address: (ÁÖ¼Ò)____________________________________________________________ Home phone: (ÁýÀüÈ)_________________ Work phone: (Á÷ÀåÀüÈ) ____________________ Cell phone: ____________________________ Email: ________________________________ Parent #2: (ºÎ¸ð2) Name: (¼º¸í)_________________________________________________ ___ Address: (ÁÖ¼Ò)____________________________________________________________ Home phone: (ÁýÀüÈ)_________________ Work phone: (Á÷ÀåÀüÈ) ____________________ Cell phone: ____________________________ Email: ________________________________ Guardian(s): (ÈİßÀÎ) Guardian #1: (ÈİßÀÎ1) Name: (¼º¸í)_________________________________________________ ___ Address: (ÁÖ¼Ò)____________________________________________________________ Home phone: (ÁýÀüÈ)_________________ Work phone: (Á÷ÀåÀüÈ) ____________________ Cell phone: ____________________________ Email: ________________________________ AUTHORIZATION AND CONSENT OF PARENT(S) OR LEGAL GUARDIAN(S) (ºÎ¸ð ȤÀº ¹ýÀû ÈİßÀÎÀÇ µ¿ÀÇ¿Í À§ÀÓ»çÇ×) 1. I hereby declare that I have legal custody of the above named child.(ºÎ¸ð´Â »ó±â ¸í±âµÈ ¾Æµ¿ÀÇ ¹ýÀû ÈİßÀÎÀ» ÁöÁ¤ÇÑ´Ù.) 2. I hereby grant my full permission and consent for the temporary guardian to establish a place of residence for my child, and for my child to reside and travel with said temporary guardian. (ºÎ¸ð´Â Àӽà ÈİßÀο¡°Ô ¾ÆÀ̰¡ ÈİßÀΰú ÇÔ²² Áö³¾ Àå¼Ò¸¦ Á¤ÇÒ ¼ö ÀÖ´Â ±ÇÇѰú ÇÔ²² ¿©ÇàÇÒ ¼ö ÀÖ´Â ÀÏüÀÇ ±ÇÇÑÀ» À§ÀÓÇÑ´Ù.) 3. I hereby grant the temporary guardian my full authorization to make all decisions related to my child¡¯s educational, religious, and recreational activities and undertakings. (ºÎ¸ð´Â Àӽà ÈİßÀο¡°Ô ¾ÆÀÌÀÇ ±³À°, Á¾±³, ¿©°¡ Ȱµ¿¿¡ °üÇÑ ¸ðµç °áÁ¤±ÇÀ» À§ÀÓÇÑ´Ù.) 4. I hereby grant the temporary guardian my full authorization to administer general first aid treatment for any minor injuries or illnesses experienced by the minor. If the injury or illness is life threatening or in need of emergency treatment, I authorize the temporary guardian to summon any and all professional emergency personnel to attend, transport, and treat the participant and to issue consent for any X-ray, anesthetic, blood transfusion, medication, or other medical diagnosis, treatment, or hospital care deemed advisable by, and to be rendered under the general supervision of, any licensed physician, surgeon, dentist, hospital, or other medical professional or institution duly licensed to practice in the state in which such treatment is to occur. (ºÎ¸ðÀÇ ÀüÀûÀÎ ±ÇÇÑ À§ÀÓÀ¸·Î Àӽà ÈİßÀÎÀº ¾ÆÀ̰¡ °æ¹ÌÇÑ »óó¸¦ ÀÔ¾úÀ» °æ¿ì ÀϹÝÀûÀÎ ±¸±Þ¾à Á¶Ä¡¸¦ ÇÒ ¼ö ÀÖÀ¸¸ç, ¶ÇÇÑ »ý¸íÀ» À§ÇùÇÏ´Â Áß»óÀ¸·Î ÀÀ±Þ»óȲ ½Ã Àΰ¡µÈ Àü¹®ÀÇ·áÁøÀ¸·Î ÇÏ¿©±Ý ÁøÂû, ÈļÛ, Ä¡·á¸¦ ÇÒ ¼ö ÀÖµµ·Ï Çϸç, ¶ÇÇÑ ¿¢½º·¹ÀÌ, ¸¶Ãë, ¼öÇ÷, Åõ¾à ¹× Àü¹®ÀÇ·áÁøÀ̳ª ±â°ü¿¡¼ ÇÊ¿äÇÏ´Ù°í ±Ç°íÇÏ´Â ¸ðµç ÀÇÇÐÀû Á¶Ä¡¸¦, »óȲÀÌ ¹ß»ýµÈ ÇØ´ç ÁÖ¿¡¼ ¹ÞÀ» ¼ö ÀÖµµ·Ï ÇÑ´Ù) 5. This authorization is effective commencing on the ______day of ___________, 20_____ and expiring on the ______day of __________, 20____. (»ó±â ±ÇÇÑ À§ÀÓÀº _________¿¡ ½ÃÀÛÇÏ¿©_________±îÁö À¯È¿ÇÏ´Ù.) 6. For the duration that the temporary guardian cares for my child, the costs associated with my child¡¯s maintenance, living expenses, medical expenses shall be allocated and paid as follows: the said guardian will make full payments in behalf of the parents. (Àӽà ÈİßÀÎÀÌ ¾Æµ¿À» µ¹º¸´Â ±â°£¿¡ ¹ß»ýÇÏ´Â ¾Æµ¿ÀÇ °¢Á¾»ýȰºñ, ÀÇ·áºñ¸¦ ºÎ¸ð¸¦ ´ë½ÅÇÏ¿© ÈİßÀÎÀÌ Àü¾× ºÎ´ãÇÑ´Ù.) I attest to the truthfulness, accuracy, and validity of the forgoing statement. (º»ÀÎÀº »ó±âµÈ ¸ðµç Áø¼úÀÇ Áø½ÇÇϰí, Á¤È®Çϸç, ±×¸®°í À¯È¿ÇÔÀ» Áõ¸íÇÑ´Ù.) Parent 1¡¯s signature: (¼¸í)_____________________________ Date: ____________________ Parent 2¡¯s signature: (¼¸í)_____________________________ Date: ____________________ CONSENT OF TEMPORARY GUARDIAN (Àӽà ÈİßÀÎ µ¿ÀÇ) I hereby acknowledge the terms set forth above and agree to assume responsibility in accordance with those terms. (º» Àӽà ÈİßÀÎÀº »ó±â »çÇ×À» ÀÎÁ¤ÇÏ¸ç ±× »çÇ׵鿡 ¸í±âµÈ Ã¥ÀÓÀ» Áø´Ù) I attest to the truthfulness, accuracy, and validity of the forgoing statement. Temporary Guardian 1¡¯s signature: (¼¸í)_________________________ Date: _____________ CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC (°øÁõÈ®ÀÎ) : Official Notary Certificate of this Guardian Appointment Signed by a Notary Public in the Republic of Korea. (´ëÇѹα¹ °øÁõÀο¡ ÀÇÇØ ¼¸íµÈ ÈİßÀÎ ÁöÁ¤ÀÇ °ø½Ä ÀÎÁõ) |
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